Posted on 07/14/2003 8:36:39 AM PDT by Cinnamon Girl
The failure of footballer of George Best to refrain from drinking alcohol despite a life-saving liver transplant just 12 months ago has prompted questions about the merits of offering transplant surgery to alcoholics.
Some say it is a waste of a precious and scarce resource, but others say there is no reason why people suffering from such a debilitating disease should be discriminated against.
The George Best case may give the impression that people suffering from alcoholism take their place in the transplant queue like any other person with severe liver disease.
In fact, this is not the case. Many units operate a vigorous screening policy to determine whether there is a good chance that a patient will give up dangerous drinking following surgery.
If the signs are bad, then they may very well be denied a transplant.
The Scottish Liver Transplant Unit in Edinburgh is one which takes this line.
It is headed by Mr John Forsythe, vice president of the British Transplantation Society.
He told BBC News Online: "You could say no patient with alcoholic liver disease should receive a transplant, but that would be pretty harsh on the truly reformed alcoholic who would do very well.
"Alternatively, you could say that that these patients should always be considered for a transplant, but that is plainly ridiculous.
"In cases where the likelihood of recidivism is high that would mean a vital resource given after a lot of thought by a donor family is likely to be wasted.
"That leaves us with something in between. We have a robust procedure to assess whether there is a good chance that a patient will not return to harmful drinking.
"If there is, then we will consider surgery. After all we have a duty of care to the recipient which is obvious, but we also feel we have a duty of care to the donor family."
Mr Forsythe said the chances of a patient returning to dangerous levels of drinking following surgery were low. Around 15-20% of patients do drink following surgery, but only about 2% of these do so at levels which could damage their new liver.
Long-term commitment
Dr Robert Lefever, who runs the Promis Recovery Centre for addicts in Kent, believes that patients with alcoholic liver disease should only be offered surgery if they have made a tangible commitment to staying off drink.
"People need to go to Alcoholics Anonymous and demonstrate that they understanding that they have to make a long-term commitment to tackling their problems," he said.
"Just simply saying 'I'm never going to drink again' is not good enough - anybody could say that."
Many would question whether George Best was a suitable candidate for surgery.
But his surgeon is not one of them. Professor Roger Williams said Best's weekend drinking session - which included a scuffle with a photographer, was a temporary lapse.
"Up to about a week ago he had been in extraordinarily good form," he said.
"He was at a House of Commons reception to launch a joint parliamentary group on liver disease and I had never seen him look so well, or talk so well. He was altogether a transformed person."
Sympathy required
Eric Appleby, of the charity Alcohol Concern, agreed. He stressed that Best needed sympathy - not criticism.
He said: "This isn't like swapping over a component in your car. If you get a new liver, it doesn't stop the problems you had which got you into trouble in the first place.
"I'm sure George Best was absolutely sincere in his wish to stop drinking.
"But drinking in this country is almost how you define yourself, and sitting at home with a glass of orange juice is not what a guy like him has been used to.
"How he leads his life, where his mates are, what he does is down the pub, and it's a tough call to cut that out of your life."
Mr Appleby rejected the idea that alcoholics should be made a low priority for a liver transplant.
"Whatever aspect of health you look at there is always some contributory factor.
"What we need to ensure is that those people who do get transplants actually get the help and support they need to make the most of it."
Deepak Mahtani is from the organisation Transplants in Mind, which works to increase public awareness of the benefits of organ donation.
He said everybody deserved equal treatment from the NHS - including George Best.
"When he received the liver transplant a year ago he made a resolution to stop drinking, and I do believe he was sincere in that.
"Nevertheless, drinking is part of the society in which we live, and he is only human with human frailties."
Mr Mahtani accepted that the negative publicity surrounding Best might put some people off donating their organs.
"I have heard people saying 'why should we register on the organ donor register if our organs are going to be wasted in this way'. But I don't think this is the rule, this is an exception."
Media criticism
Best also won support from Labour MP Helen Clark, a member of the all-party hepatology group, which the footballer helped to launch last week.
She criticised the media for adding to the pressure on Best by camping outside the pub in which he was seen drinking.
"George hadn't touched a drop of alcohol for three years, and nobody knows what caused this blip.
"He is not an evil, wicked person behaving in a terrible, bad way, he is ill, and he does need help."
In this country, we have condemned criminals on death row who get organ transplants. Makes about as much sense as dabbing their arms with alcohol before giving them the lethal injection, wouldn't want them to get an infection.
There's an important distinction here. First thing is that the remedies you propose for the diseases are medicine, not an organ. Secondly, my issue is against giving livers to alcoholics that continue to drink after they receive a new organ (as opposed to those that have been on the wagon for years).
My major issue is for alcoholics getting a new liver...a new lease on life...and continue to drink. That's a waste of a good liver. From experience, I've seen people that have made drastic changes in their lifestyle because their health was affected. It's those that feel they have a right to another liver gives them a right to continue to live the same lifestyle. It's just a waste... Conservatives point to personal responsibility and consequences for one's actions. Liberals make excuses. Alcoholics can drink themselves into the ground...it's their life. But my issue is that they want a 2nd lease on life...and then continue drinking...the same thing could apply to the smoker that had a lung removed and still smokes...or the obese person that had a heart attack and still eats crap.
Point (2): Because market solutions are not applied to organs. The alternative to establishing a profit motive, is for the government to "donate" the organs of prisoners like they do in enlightened countries like China. Perhaps you would want the government to use their police powers to force everyone in this country to be an organ donar? The Pro-Choice crowd ought to love that prospect.
If you're proposing that donor's be paid for organs (actually, it would likely be next-of-kin or covered in a will), then that would be a valid market solution to the issue of organ shortage. Of course I'm NOT in favor of government mandating organ donation.
Point (3): You are not calling yourself god, and making organ transplants an entitlement to those who you seem more noble. In a country that seems to hate a system of merit, you are establishing a system of where more people are equal than others. The problem with your supposed solution in that you enact a Santa Claus Organ Donar Program where a list of Naughty and Nice is kept, is that this is a program that begs to be thoroughly corrupted both politically and through money.
No, I never proposed a solution. I'm railing against alcoholics that continue to drink feeling like they deserve the same rights. Maybe I have an axe to grind...but I've seen firsthand an alcoholic that received a liver transplant continue to drink and ruin the new liver.
I am sure that if this country's founders were alive today, they would cough up their own liver in response to such brazen Statist elitism and claims to another person's health and organs. Clearly you have no faith in the free market system to solve this, and you want the Morality Police to autocratically insert themselves into every organ transplant procedure. That's not liberal or conservative, that is megalomaniacal and the epitome of self-righteous arrogance.
But I would rather the free market resolve this issue. However, I don't see how the free market will prevent an alcoholic from ruining a new liver...which is my axe to grind. What would be your free market solution?
It didn't take long before you made an off topic attack on those who don't agree with you by trying to tie them to a group with whom you do not agree.
I get the impression that some people make comments based on the "real" situation even though their "solutions" HAVE been tried, and which never work, not to mention are immoral.
The same kind of people argue over the details of immoral and unconstitutional government programs instead of opposing them on principle. They accept these programs when they debate how the plunder will be divided.
You look at fundamentals and break it down and the answers are easier.
The person who owns the organ (donor) makes the call on who gets it. If people could be compensated for their organs, they would be readily available, which makes the shortage problem less. (if not disappear)
Second, when someone receives the organ, It belongs to them, and they can do what they please with it, including ruining it.
Thirdly, going down the path of groups of people deciding who is deserving and who isn't is folly. Taken to it's logical conclusion, it might be decided based on race or other illegitimate factors by some people of bad will.
Having experienced socialized medicine personally, I prefer and advocate private medical coverage whole-heartedly. Giving the decision of who gets an organ donation to the donor does not remove the ethical question, and the more socialized and without religious/ethical guidance our society becomes, the more we will be diminishing the value of life.
No argument there. But then again, my neighbor's business hasn't been delegated to me. Until I receive power of attorney by the recipient or the donor, it would seem to me that my life is already too complex to fret worrying about if someone else's liver is a waste or not.
But I would rather the free market resolve this issue. However, I don't see how the free market will prevent an alcoholic from ruining a new liver...which is my axe to grind. What would be your free market solution?
Personally, I see it as a solution seeking a problem. Change the liver to an automobile and reapply the unrepentant alcoholic scenario. Let's say the alcoholic crashes his vehicle. Now he wants another one. Should the alcoholic be eternally banned from purchasing another? Tough call unless you have a crystal ball, or just think that you have the ultimate power over another person's life and feel that draconian actions make for the most effective consequences. An alcoholic is only a problem if he drives inebriated on the roadways. But what if he doesn't ever drive drunk but is still an alcoholic? See, your proposal is very presumptive. You said that given another liver, the alcoholic will just go ahead and ruin it, then a couple of sentences later you gave anecdotal evidence that similar people had a Road to Damascus moment. Why would you admit that people change, but say that the token alcoholic got off the road an exit earlier? To me, this smacks of Situational Ethics Indoctrination where we have a boatload of people and we pitch over the priest and the alcoholic because the first will go to heaven, and we just don't like the alcoholic. Crimes, not medical solutions should be tried by jury. The contents of the alcoholic's personal bank account should have more influence on the decision than a bunch of self-righteous hypocrites with an ax to grind over a politically incorrect disability.
Others have posted a free-market response, and I don't think that it would be any worse than the system we have now. Though human nature, particularly in this day and age, hates those who have can buy their way out of trouble, and prefers to coddle those who think that everything is an entitlement. News of some rich guy buying a liver on eBay will just fire-up the Class Envy Crowd and stoke the fires of more Soak The Rich Politics. It is almost to the point if a person can use their own resources to bail themselves out of trouble are worse than those who feel that it is everyone's obligation to erase all of the negative consequences of their life.
Me, personally? I am not afraid of death, nor do I feel that persuing eternal life in this dumpster is noble or something that others should sacrifice their sweat and time to provide. For athiests, I can understand plundering the medical system and bending the rules to favor their case. For Christians, a DNR on their driver's license would seem more appropriate reflection of their faith.
The ethics should never be left to unethical. And government is inherently unethical. If left to government, the value of life will be nil.
Maybe I should have put a caveat in my original reply. If the alcoholic is not drinking, and if they pay for the transplant themselves, and if it does not take a liver from someone who lost their's through no fault of their own, then, I think the alcoholic should get a liver. Actually I am quite compassionate, but you're not a very good speller are you?
This is a forum for articles and opinions, I expressed mine. My opinion stands on it's own, your spelling does not.
Good point. I don't seek a government solution. Perhaps my issue is personal responsibility and those that benefit from their lack of responsibility.
The contents of the alcoholic's personal bank account should have more influence on the decision than a bunch of self-righteous hypocrites with an ax to grind over a politically incorrect disability.
Political incorrect disabilities have little to do with the matter. I don't look at alcoholism or drug addiction as being politically incorrect. The liberals bring these up as a disease rather than a choice (granted, it may be a difficult choice, but by labeling it a disease, it makes it more palatable). If organs weren't in short supply and the free market did rule, then this argument would be moot.
You said that given another liver, the alcoholic will just go ahead and ruin it, then a couple of sentences later you gave anecdotal evidence that similar people had a Road to Damascus moment. Why would you admit that people change, but say that the token alcoholic got off the road an exit earlier?
I don't take issue with the person that has quit drinking for 10 years and has found a healthier lifestyle...yet ends up with liver disease. I do take issue with those that don't stop drinking.
Others have posted a free-market response, and I don't think that it would be any worse than the system we have now. Though human nature, particularly in this day and age, hates those who have can buy their way out of trouble, and prefers to coddle those who think that everything is an entitlement. News of some rich guy buying a liver on eBay will just fire-up the Class Envy Crowd and stoke the fires of more Soak The Rich Politics. It is almost to the point if a person can use their own resources to bail themselves out of trouble are worse than those who feel that it is everyone's obligation to erase all of the negative consequences of their life.
You're right when it comes to the class war that would break out..., yet I'm against people buying their way out of trouble. Enevitably, its your life to do what you choose, but you should have to live with the consequences of your actions (both good and bad).
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